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3. Equine 2 > INFLAMMATORY AIRWAY DISEASES > Flashcards

INFLAMMATORY AIRWAY DISEASES Flashcards

1
Q

important inflammatory airway diseases of the horse

A

▪ Exercise-Induced Pulmonary Hemorrhage
▪ Mild-Moderate Equine Asthma
▪ Severe Equine Asthma

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2
Q

EXERCISE-INDUCED PULMONARY HEMORRHAGE
- Signalment

A
  • any horse that works at a high rate of speed for any length of time
    <><>
    Signalment
    ▪ Any age
    ▪ Any breed
    > Thoroughbreds
    > Standardbreds
    > Quarter horses
    ▪ Any sex
    ▪ Genetic component?
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3
Q

EIPH
▪ Pathogenesis

A

▪ During strenuous exercise, shear forces across the lung > Mean pulmonary artery pressure > > 90mm Hg
> Increased capillary pressure
> Pulmonary capillary failure
> Extravasation of blood
▪ Arteriovenous remodelling > more likely to bleed again, ie. predisposition after first time
> Loss of compliance
> Increased capillary pressure
> Pulmonary capillary failure
> Extravasation of blood

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4
Q

EIPH
▪ Prevalence
▪ Clinical signs
▪ Diagnosis

A

Prevalence
▪ Epistaxis= 0.15-0.84% (very rare)
▪ Airway hemorrhage= 45-90%
<><>
Clinical signs
▪ Epistaxis
▪ Abnormal lung sounds
▪ Decreased/poor performance
<><>
Diagnosis
▪ Epistaxis post strenuous exercise
▪ Endoscopy
▪ Bronchoalveolar lavage (within 2 weeks)

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5
Q

EIPH
▪ Treatment, prophylaxis

A

▪ No treatment currently available
<><><><>
Prophylaxis
▪ Furosemide, 4 hours prior to exercise (modulates blood pressure)
<><>
investigated but no effect
▪ Anti-inflammatories
▪ Bronchodilators
▪ Phosphodiesterase inhibitors
▪ Procoagulants
▪ Nasal dilator strips

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6
Q

EIPH
▪ Prognosis

A

Guarded for strenuous exercise
▪ Horses with epistaxis more likely to have epistaxis again
▪ Horses with grades 3-4 hemorrhage
> More likely to have poor performance and shorter career
<><><><>
▪ May develop pulmonary fibrosis
▪ Risk of fatal hemorrhage very low
<><><><>
- but in terms of survival, there are no problems

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7
Q

MILD-MODERATE EQUINE ASTHMA
▪ Definition

A

▪ Dysregulation of inflammatory cell
homeostasis in the airway lumen leading to
variable clinical signs
<><>
▪ Previously > Inflammatory airway disease

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8
Q

MILD-MODERATE EQUINE ASTHMA signlament

A

▪ Young- middle age
▪ Any breed
▪ Any sex

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9
Q

MILD-MODERATE EQUINE ASTHMA
▪ Risk factors, pathophysiology

A

▪ Stable housing
▪ Poor ventilation
▪ Presence of airway irritants
▪ Respiratory infection
<><><>
Pathophysiology
▪ Multifactorial
▪ Increased airway mucus
▪ Airway hyperresponsiveness
▪ Increased % of one or more cell types

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10
Q

MILD-MODERATE EQUINE ASTHMA
▪ Clinical signs

A

▪ Decreased performance
▪ Delayed recovery after exercise
▪ Exercise intolerance
▪ Chronic, intermittent cough
▪ Serous-mucoid nasal discharge

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11
Q

MILD-MODERATE EQUINE ASTHMA
diagnosis

A

▪ Endoscopy
▪ Bronchoalveolar lavage
▪ Rule-out other etiologies

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12
Q

mild-moderate equine asthma grading scale correlates with what?

A
  • number of neutrophils we see on BAL
    <><><><>
    Tracheal mucous score
    ▪ Positively correlated with neutrophil %
    ▪ Negatively correlated with eosinophil %
    <><><><><>
    Bronchoalveolar lavage
    ▪ >10% neutrophils
    ▪ or
    ▪ > 2-5% mast cells
    ▪ or
    ▪ >1-2% eosinophils
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13
Q

MILD-MODERATE EQUINE ASTHMA
▪ Phenotypes

A

▪ Neutrophilic
▪ Eosinophilic
▪ Metachromatic/mastocytic

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14
Q

Neutrophilic mild-moderate equine asthma
- who gets it?
- associated with?

A

▪ Most common in horses > 7 years old
▪ Associated with:
▪ Chronic coughing
▪ Increased tracheal mucus
▪ Cold, dry environments

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15
Q

Eosinophilic milkd-moderate equine asthma
- who gets it?
- associated with?

A

▪ Most common in horses < 5 years of age
▪ Associated with:
▪ Respirable dust exposure
▪ Not correlated to parasitism
▪ Airway hyperresponsiveness

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16
Q

Metachromatic/mastocytic mild-moderate equine asthma
- association, characteristics?

A

▪ Airway hyperresponsiveness
▪ Poor performance
▪ Most difficult to manage > no good drug that is a mast cell stabilizer

17
Q

MILD-MODERATE EQUINE ASTHMA
▪ Treatment principles
- systemic treatment options

A

Treatment principles
▪ Decrease pulmonary inflammation
▪ Decrease airway hyperresponsiveness
▪ Decrease airway mucous production
▪ Environmental management
<><><><>
Systemic treatment options
▪ Corticosteroids
> Dexamethasone
> Prednisolone
▪ Bronchodilators
> Clenbuterol
> Aminophylline

18
Q

SEVERE EQUINE ASTHMA
▪ Definition

A

Chronic, progressive, severe pulmonary
inflammation
▪ Excessive mucus production
▪ Airway neutrophilia
▪ Bronchial hyperreactivity
▪ Bronchospasm
<><><><>
- a horse with mild-moderate will not necessarily ever have a severe case! and horses can have a severe case without having prior cases.

19
Q

SEVERE EQUINE ASTHMA
▪ Signalment, clinical signs

A

Signalment
▪ Usually middle-aged or older
▪ Any breed
▪ Any sex
<><><><>
Clinical signs
▪ Chronic cough
▪ Serous- mucoid nasal discharge
▪ Increased respiratory effort at rest
▪ Severe exercise intolerance
▪ Episodic respiratory distress
▪ Weight loss

20
Q

SEVERE EQUINE ASTHMA
▪ Two subtypes

A

Barn-associated
▪ Temperate-cool climates
▪ Clinical late fall-winter
▪ Housed primarily in stall/barn
<><><><>
Summer pasture-associated
▪ Hot, humid climates
▪ Clinical spring-late fall
▪ Housed at pasture

21
Q

SEVERE EQUINE ASTHMA
▪ Diagnosis

A

▪ History
▪ Physical examination
> Increased respiratory effort at rest
-> Abdominal lift
-> Nostril flaring
-> “heave line”
-> Audible wheezing
▪ Auscultation
> High and low-pitched expiratory wheezes
▪ Response to inhaled or systemic bronchodilator
<><><><>
Endoscopy
▪ Scant - mild tracheal mucous
▪ Collapsing bronchi > shouldnt be responding to this mechanical stimulus in healthy animal
<><><><>
Bronchoalveolar lavage (this is the best!)
▪ >20% neutrophils
<><><><>
▪ Thoracic ultrasonography?
▪ Thoracic radiographs
▪ Pulmonary function testing
> Bronchoprovocation
▪ Biopsy
> Endoscopic
> Thorascopic

22
Q

horse with severe equine asthma may also have what other disease? why?

A

MAY ALSO HAVE PNEUMONIA
▪ Impaired pulmonary defences
▪ Impaired airway clearance

23
Q

SEVERE EQUINE ASTHMA
▪ Principles of treatment

A

▪ Reverse bronchoconstriction
▪ Decrease airway inflammation
▪ Treat concurrent pneumonia
▪ Modify the environment
▪ Treat early and aggressively

24
Q

severe equine asthma - chronic and progressive cases can have what issues?

A

▪ Cachexia
▪ Bullae
▪ Pneumothorax
▪ Pneumonia/pleuropneumonia
▪ Pulmonary edema
▪ Cor pulmonale
▪ Heart failure

25
Q

SEVERE EQUINE ASTHMA
- treatment options

A

▪ Inhaled bronchodilators
> Lev-albuterol
▪ Systemic bronchodilators (better as they can more easily affect the deepest airways)
> Clenbuterol
> N-butylscopalamine
> Atropine
▪ Intranasal oxygen
▪ Systemic corticosteroids
> Dexamethasone
> Prednisolone
▪ Inhaled corticosteroids

26
Q

SEVERE EQUINE ASTHMA
▪ Environmental management for Barn-associated

A

▪ Wet hay prior to feeding
▪ Feed on the ground
▪ Feed all-pelleted diet
▪ Remove round bales
▪ Use low-dust/ no bedding
▪ Improve ventilation in barn
▪ Remove any hay stored in loft
▪ Increase turnout time
▪ Remove horse from barn when cleaning

27
Q

SEVERE EQUINE ASTHMA
▪ Environmental management for Pasture-associated

A

▪ Decrease time on pasture
▪ Mow pastures frequently
▪ Turn out in dry lot
▪ Well-ventilated stall > Fans in stall
▪ Wet hay or feed all-pelleted diet
▪ Use low dust bedding
▪ House away from fields during harvest

3. Equine 2 (16 decks)

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